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NC WIC Program Manual October 2017
Chapter 1
Introduction to WIC
Table of Contents This chapter provides an introduction to the WIC Program and information on the required no
smoking policy, retention of program records, staff conflict of interest, management of program
policies and procedures, and resources available from the Nutrition Services Branch to support
program activities.
Section 1. Overview of WIC .....................................................................................................1
▪ Introduction
▪ WIC Program Benefits
▪ Eligibility For WIC
▪ Participation In WIC
▪ Impact Of WIC On Health Status
▪ WIC In North Carolina
Section 2. No Smoking Policy In Local Agency Facilities ......................................................5
Section 3. Program Policies And Procedures ...........................................................................7
▪ Distribution Of The Program Manual
▪ Updating Program Policy
▪ Local Agency Policies And Procedures
Section 4. Staff Conflict Of Interest .........................................................................................9
▪ Certifying And Issuing Food Benefits To Self, Relatives, Or Close Friends
▪ Certifying And Issuing Food Benefits By The Same Staff Person
▪ WIC Employees And WIC Vendors
Section 5. Program Materials Available From The Nutrition Services Branch .....................11
▪ Ordering Materials
▪ Receiving Materials
Attachments:
Attachment 1. Log of WIC Program Numbered Memos (sample)
Attachment 2. Separation of Duties Log
NC WIC Program Manual October 2017
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Chapter 1: INTRODUCTION TO WIC 1
Section 1: OVERVIEW OF WIC
NC WIC Program Manual October 2017
Overview of WIC
The Special Supplemental Nutrition Program for Women, Infants, and Children, more
commonly known as WIC, is a federal program administered by the United States Department of
Agriculture (USDA). The program is designed to provide food and nutrition education to low-
income pregnant and postpartum breastfeeding women and infants/children until age five.
Additional information on WIC can be found at http://www.fns.usda.gov/wic/.
Introduction
The purpose of the WIC Program is spelled out in Section 17 (a) of Public Law 95-627
(Child Nutrition Amendments of 1978).
The Congress finds that substantial numbers of pregnant women, infants, and young
children are at special risk in respect to their physical and mental health by reason of
poor or inadequate nutrition or health care, or both. It is, therefore, the purpose of the
program authorized by this section to provide supplemental nutritious foods and nutrition
education as an adjunct to good health care during critical times of growth and
development in order to prevent the occurrence of health problems and improve the
health status of these persons.
It is the philosophy of the North Carolina WIC Program that in order to fulfill the legislated
purpose of the Program, the following must be present at the level of implementation:
... integration of WIC with established health services; emphasis on the WIC food
package as a prescription; and nutrition education services tailored to the needs of the
individual target population participant.
Transformation of this philosophy into reality has been and continues to be a challenge to
those concerned with WIC at the local, regional, and state level. They have dealt with the
difficulties of communicating and demonstrating the novel concept of the food prescription
to the lay and professional community. They have worked to ensure the survival of the
Program through the past few challenging legislative and funding cycles. With the continued
dedication of the nutritionists, nurses, physicians, interviewers, bookkeepers, and
administrators throughout the North Carolina WIC Program areas, the goal of improving the
physical and mental growth and development of WIC participants in North Carolina will be
accomplished.
WIC Program Benefits
WIC Food Prescription. The foods available through WIC are foods containing
nutrients determined to be beneficial for pregnant, breastfeeding, and postpartum women,
infants and children. Refer to Chapter 7 for information on the specific types and
quantities of foods available through the WIC food prescription for WIC Program
participants.
Nutrition Education. Nutrition and physical activity education is an integral part of the
Chapter 1: INTRODUCTION TO WIC 2
Section 1: OVERVIEW OF WIC
NC WIC Program Manual October 2017
WIC Program and is designed to improve health status, achieve positive change in
dietary habits, and emphasize relationships between nutrition and health, all in keeping
with the individual's personal, cultural, and socioeconomic preferences. Refer to Chapter
5 for information on the nutrition education benefit of the WIC Program.
Breastfeeding Promotion And Support. Pregnant and postpartum women who
participate in WIC receive comprehensive breastfeeding education and support. Refer to
Chapter 9 for information on the breastfeeding associated benefit of the WIC Program.
Referrals to Health Care and Public Assistance Programs. WIC Program applicants
and participants receive information on and referrals to other relevant health care
services (e.g., immunization services, prenatal care, well child health care), appropriate
public assistance programs (e.g., Food and Nutrition Services, Medicaid), and potential
sources for food assistance.
Eligibility For WIC
To qualify for the North Carolina WIC Program, an applicant must meet four eligibility
criteria. Refer to Chapter 6 for additional information about each of these criteria.
Categorical eligibility. A participant must be a pregnant woman, a non-breastfeeding
woman up to six months postpartum, a breastfeeding woman up to one year postpartum,
an infant, or a child up to the fifth birthday.
Residential eligibility. A participant must live in the State of North Carolina and in the
health services delivery area of the local agency.
Income eligibility. A participant must have a gross annual income at or below 185% of
the federal poverty line. All Medicaid, TANF (Work First), and Food and Nutrition
Services recipients are automatically income-eligible for WIC (i.e., adjunctively
eligible).
Nutrition risk eligibility. A participant must have an identified medical/nutritional risk
problem, as determined by a competent professional authority (CPA). Risks include
anemia, poor growth, previous poor pregnancy outcome, inadequate diet, and other
nutrition-related problems.
Participation In WIC
Over 233,164 North Carolina women, infants, and children receive WIC Program services
each month. Monthly participation in WIC is defined as the sum of:
the number of pregnant women, breastfeeding women, non-breastfeeding postpartum
women, infants and children who received food instruments or cash-value vouchers
during the reporting period;
the number of breastfeeding infants who did not receive food instruments, but whose
breastfeeding mother received food instruments or cash-value vouchers during the
Chapter 1: INTRODUCTION TO WIC 3
Section 1: OVERVIEW OF WIC
NC WIC Program Manual October 2017
reporting period; and
the number of breastfeeding women six months or more postpartum who did not receive
food instruments or cash-value vouchers, but whose breastfed infant(s) received food
instruments during the reporting period.
Refer to Chapter 7 for more information on the food benefit of WIC and to Chapter 8 for
information on the issuance of this benefit.
Impact Of WIC On Health Status
Over the years, USDA has conducted extensive evaluations of the WIC Program as have a
variety of other groups, including the federal General Accounting Office (GAO). The
positive impact of WIC on its participants has been shown to be varied and significant.
Participation in WIC during pregnancy is associated with lower rates of infant mortality,
fetal mortality, perinatal mortality, and neonatal mortality. Evidence suggests that
improved pregnancy outcomes to women participating in WIC saves significant dollars
in newborn medical and intensive neonatal care costs.
Infants born to women receiving WIC during pregnancy have lower rates of low birth
weight and have head circumferences the same size or larger than infants born to low-
income women who were not on WIC during their pregnancies.
Children enrolled in WIC are more likely to have better diets and are more likely to
participate in regular preventive health services and be better immunized than children
who are not participating in WIC.
WIC appears to improve intelligence of children long after the pregnancy. Four and five
year olds whose mothers participated in WIC during pregnancy were shown to have
better vocabulary scores than comparable non-WIC children. Children who
subsequently participated in WIC after their first birthday appeared to have better digit
memories than children who did not participate in WIC.
WIC In North Carolina
WIC is administered at the State level by the NC Department of Health and Human Services,
Division of Public Health, Women’s and Children’s Health Section, Nutrition Services
Branch. Locally, the WIC Program is administered by public health agencies (e.g., county
health departments and community and rural health centers) serving all 100 counties.
Additional information about the North Carolina WIC Program can be found at
www.nutritionnc.com.
In addition to the WIC Program federal regulations (http://www.fns.usda.gov/wic/wic-laws-
and-regulations) program activities are governed by rules outlined in the North Carolina
Administrative Code (NCAC), Title 10A Health and Human Services, Chapter 43,
Subchapter D. The NCAC can be accessed online at http://www.oah.state.nc.us/rules/ At
this website, select Administrative Code Online to access the NCAC Table of Contents.
Once at the NCAC Table of Contents, complete the fields at the top of the web page as noted
Chapter 1: INTRODUCTION TO WIC 4
Section 1: OVERVIEW OF WIC
NC WIC Program Manual October 2017
below and click “Look Up”
10ANCAC
43D Look-Up
Chapter 1: INTRODUCTION TO WIC 5
Section 2: NO SMOKING POLICY IN LOCAL AGENCY FACILITIES
NC WIC Program Manual October 2009
No Smoking Policy In Local Agency Facilities
To receive WIC administrative funds, local agencies and WIC clinics must have an announced
public policy that prohibits smoking. This policy applies to any space where staff conducts WIC
activities including accepting WIC applications, certifying participants, and issuing food
instruments.
This prohibition against smoking applies only to those times when the WIC Program is actually
operating. Satellite operations, such as church basements or community health centers that offer
WIC services only once or twice a week, are not required to announce and implement the non-
smoking policy when the WIC Program is not operating.
Chapter 1: INTRODUCTION TO WIC 6
Section 2: NO SMOKING POLICY IN LOCAL AGENCY FACILITIES
NC WIC Program Manual October 2009
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Chapter 1: INTRODUCTION TO WIC 7
Section 3: PROGRAM POLICIES AND PROCEDURES
NC WIC Program Manual October 2009
Program Policies and Procedures
The North Carolina policies and procedures are described in writing in the WIC Program
Manual. All staff working with the WIC Program must have ready access to the WIC Program
manual.
Distribution Of The WIC Program Manual
Each Local WIC Program receives at least one copy of the WIC Program Manual and may
request additional copies. The Local WIC Director is responsible for:
making staff aware of the manual's contents,
assuring that all copies of WIC Program Manuals in the local agency are updated when
manual revisions are received, and
providing staff with ready access to a program manual at all times.
Updating Program Policy
The Nutrition Services Branch periodically issues a numbered memorandum to reflect
changes in federal and state regulations, rules, and/or policies and procedures.
Numbered memos contain policy changes which may be short-term solutions to temporary
challenges or permanent policy changes such as a WIC Program Manual revision. Staff
should maintain a log of numbered policy memos and file the policy memos so they can be
easily retrieved. A sample numbered memos log is found in Attachment 1.
Manual revisions contain changes/clarifications which become part of the North Carolina
WIC Program Manual. When staff receives a manual revision, they should follow the
guidance in the correspondence for inserting the revision into the manual as well as for
reviewing, distributing, and implementing changes in policies and procedures.
Local Agency Policies and Procedures
At times, a Local Agency must develop a written policy and procedure specific to the agency.
Required areas within the WIC Program where an agency must have a written policy and
procedure on file are listed in the “Table of Contents” for each chapter within the NC WIC
Program Manual.
Staff is encouraged to develop the written policies and procedures using a format consistent
with that used by other programs within the agency, to have the written policies and
procedures signed and dated by the WIC Director (and any other staff per agency protocol),
and to review policies and procedures at least every two years and update as needed.
Chapter 1: INTRODUCTION TO WIC 8
Section 3: PROGRAM POLICIES AND PROCEDURES
NC WIC Program Manual October 2009
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Chapter 1: INTRODUCTION TO WIC 9
Section 4: STAFF CONFLICT OF INTEREST
NC WIC Program Manual December 2016
Staff Conflict of Interest
To preserve the integrity of the certification and food benefit issuance processes and to minimize
the potential for staff fraud and program abuse, federal regulations require the implementation of
policies and procedures that prevent conflict of interest or the appearance of conflict by local
agency staff. Refer to Chapter 8 for information on providing food benefits issuance.
Certifying and Issuing Food Benefits to Self, Relatives or Close Friends. To prevent the
appearance of conflict of interest, local agency staff must not participate in any component of
the certification process or food benefits issuance to herself/himself, relatives, or close
friends.
Relatives include spouse, parents, children, grandchildren, grandparents, brothers, sisters,
aunts, uncles, nieces, nephews, first cousins, stepparents, stepchildren, stepbrothers, and
stepsisters by blood or marriage.
Close friends cannot be defined in a way that fits every situation; therefore, local agencies
have authority to determine if a WIC applicant or participant is a close friend of a local
agency WIC staff.
WIC staff who is scheduled or who has a relative or close friend scheduled for a certification
or an appointment that includes food instrument issuance shall notify the WIC Director or
clinic supervisor, so that arrangements can be made for other staff persons to certify and issue
food instruments.
Certifying and Issuing Food Benefits by the Same Staff Person
Separation of duties. There must be a separation of duties among local agency staff so
that the same person does not complete both income eligibility determination and medical
or nutritional risk eligibility determination for the same participant. It is acceptable
however, for one staff member to conduct part of the certification (i.e., determine
nutrition eligibility) if a different staff member determines income eligibility; either staff
member may issue food benefits in this situation.
When separation of duties is not possible due to limited staff. Sometimes, separation
of duties is not possible because only one employee is available to complete both income
eligibility determination and medical or nutritional risk eligibility. Each local agency
must have a written policy that describes how the local agency ensures separation of
duties and that addresses strategies implemented when separation of duties is not
possible. The local agency policy must make it clear that the guidelines below are
followed:
Chapter 1: INTRODUCTION TO WIC 10
Section 4: STAFF CONFLICT OF INTEREST
NC WIC Program Manual December 2016
Staff completing the certification when separation of duties is not achieved must
complete the first five columns of the Separation of Duties Log (Attachment 2).
The log must be retained in consecutive order by date.
The local agency will designate staff other than the certifier (e.g., local agency
WIC Director, Health Director, or designee) to review selected certification
records (see below) for which separation of duties was not achieved.
Using the last five columns on the Separation of Duties Log, designated staff will
conduct a review of all non-breastfeeding infant certification records and at least
20 percent of the remaining certification records for which separation of duties
was not achieved. This review must occur within 14 calendar days of the
certification.
The completed Separation of Duties Log must be filed at the local agency in a
secure and retrievable manner, and shall be made available for review during state
agency monitoring events and local agency self-assessments.
The Separation of Duties Log must be retained in consecutive order by date.
The local agency WIC Director or designee must contact the agency’s Regional
Nutrition Consultant immediately if the local agency review of the Separation of
Duties Log suggests irregularities in WIC certification activity.
WIC Staff and WIC Vendors. To ensure there is no appearance of conflict of interest
regarding the relationship of local agency staff and WIC Vendors, the following policies must
be followed.
Local agency staff whose salary is paid in whole or any part by WIC Program funds are
prohibited from having financial ownership in any authorized WIC Vendor.
Local agency staff whose salary is paid in whole or any part by WIC Program funds shall
not be employed by, or handle, transact, deposit, or store WIC food instruments or cash-
value vouchers for, a WIC vendor in the same county served by the local WIC Program.
Likewise, local agency WIC staff must not have a spouse, child, or parent who is
employed by, and handles, transacts, deposits, or stores WIC food instruments or cash-
value vouchers for a WIC vendor in the same county served by the local WIC Program.
Chapter 1: INTRODUCTION TO WIC 11
Section 5: PROGRAM MATERIALS AVAILABLE FROM THE NUTRITION SERVICES
BRANCH
NC WIC Program Manual October 2014
Program Materials Available From The Nutrition Services Branch
The Nutrition Services Branch (NSB) stocks a wide variety of materials used by Local Agency
staff for WIC Program activities including breastfeeding education and support, program
outreach, nutrition education, and vendor management.
A complete list of available materials can be found on the Nutrition Services Branch Requisition
Form (DHHS 2507). The requisition form can be downloaded from the NSB website
www.nutritionnc.com under local agency resources.
Ordering Materials To order materials from the NSB, local agencies should use the NSB Requisition Form
(DHHS 2507). Staff should complete the form and mail or fax it to: Nutrition Services
Branch, 1914 Mail Service Center, Raleigh, NC 27699-1914; fax: 919-870-4818.
When ordering materials, local agencies are requested to:
coordinate orders with other staff in the agency who use NSB materials;
submit no more than one order a month to help with NSB efficiency in serving all
agencies submitting orders; and
order no more than a 3-month supply and to not stockpile materials.
Receiving Materials The Nutrition Services Branch will fill an order in its entirety and ship requested materials
within two-three (2-3) weeks of receiving a requisition form with the following exceptions.
Materials in Limited Supply. When an item(s) is in limited supply, the NSB will ship
only a portion of the quantity ordered. Your agency will receive notification that NSB
has a low stock of that item, and the difference will be shipped when the stock of that
item(s) is replenished.
Materials on Back-Order. When an item(s) is temporarily out-of-stock, the NSB will
provide notification to the agency that the item is on back-order. The item does not need
to be re-ordered; the NSB will keep the agency’s requisition on file and fill as per the
original request when the item is re-stocked.
Chapter 1: INTRODUCTION TO WIC 12
Section 5: PROGRAM MATERIALS AVAILABLE FROM THE NUTRITION SERVICES
BRANCH
NC WIC Program Manual October 2014
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Chapter 1: INTRODUCTION TO WIC Attachment 1
NC WIC Program October 2009
Log of WIC Program Numbered Memos
(sample)
Memo # Date of
Memo
Date
Received
Recipient
(initials)
Subject of Memo and/or Comments
Chapter 1: INTRODUCTION TO WIC Attachment 1
NC WIC Program October 2009
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Chapter 1: INTRODUCTION TO WIC Attachment 2
NC WIC Program Manual December 2016
Separation of Duties Log
1. Date of
Certification
2. Participant
ID
3. Participant
Category
(P,B,N,I,C)
4. Non-
BF
Infant
(Y/N)
5. Staff Name Reviewer Only (6 – 10)
P-Pregnant
B-Breastfeeding
N-Non-breastfeeding
woman
I-Infant
C-Child
Y-Yes
N-No
6. Income
Eligibility
Determined
Appropriately
(Y/N)
7. Medical
or
Nutritional
Risk
Code(s)
valid
(Y/N)
8. Correct
Food
Package
Prescribed/
Issued
(Y/N)
9. Reviewer
Name
10. Date of
Review
Chapter 1: INTRODUCTION TO WIC Attachment 2
NC WIC Program Manual December 2016
Instructions for Completing Separation of Duties Log
For the certifier:
1. When separation of duties is not possible, complete the first five columns (1 through 5) on the date that the certification occurs.
2. Enter the date of certification, Crossroads participant ID number, and participant category.
3. Answer the question regarding whether the participant is a non-breastfeeding infant (The policy memorandum does not define non-
breastfed infant. For the post record review requirement, all food packages containing infant formula must be reviewed).
4. Sign in the staff name column.
For the reviewer:
1. Within 14 days of the certification date, the designated reviewer will conduct a post review of all non-breastfeeding infants’ certification
records and at least 20 percent of the remaining certification records by completing the remaining five columns (6 through 10).
2. Log into Crossroads and navigate to Income Information under Certification quick links. Expand Income History and review Selected Row
Details for the date of the certification being reviewed. Determine if income eligibility was determined appropriately by checking for
verification details of adjunctive eligibility; identifying the source, proof, frequency, amount, and duration if not adjunctively eligible;
viewing the scanned affidavit if no proof of income exists; or viewing the reason for zero income if zero income was documented. Assess
for unexpected or irregular patterns among the certification records reviewed, such as frequent use of zero income or frequent round or
repeated numbers in income amounts. Indicate yes or no based on whether income appears to be determined appropriately. (See the WIC
Program Manual, Chapter 6B and Attachment 1 for more information.)
3. Navigate to the Care Plan Summary under Care Plan quick links. Expand the care plan for the participant’s record being reviewed. View
the assigned risk codes for the certification being reviewed and determine if they are valid. Document findings on the log.
4. Navigate to the Care Plan Detail under Care Plan quick links. Expand the care plan for the participant’s record being reviewed and
determine if the correct food package was prescribed by examining the current food prescription. Determine if the prescription consistent
with participant category and documentation in the nutrition assessment. Document findings on the log.
5. Sign in the reviewer name column, and enter the date the record was reviewed in the date column.
6. If the reviewer answered no to any questions, notify the agency’s Regional Nutrition Consultant immediately or no later than within one
business day of identification.